The present embodiments relate generally to a process for managing health care and address many of the problems faced today by those involved with health care: payers, patients, and providers. The methods relate particularly to techniques for improving personalized care at hospitals that interface health plan associations who have decided to seek health care services from a doctor and/or some other type of health care provider. These calls are answered by nurses and/or other types of health care professionals, who use the proprietary information tools and processes of the network management system to help patients assess their health needs and then select appropriate care.
The United States ranks first in the world in per-capita health care expenditures. At a time when national health care costs continue to escalate at an alarming rate, managed-care companies and the government have been successful in holding down payments to hospitals; but too often the patient feels unattached from the process. This feeling often leads to a reluctance of patients to seek out the help they need.
Additionally, profit margins of hospitals are decreasing yearly. To survive financially, hospital administrators have been forced to develop novel means of ensuring that their hospital is properly compensated for all services rendered and that patients are treated in manner that encourages them to return to the hospital in times of need. Today, the provision of medical care or personal care for a patient in a hospital often assumes a subordinate role to the extensive amount of information that the hospital requires from the patient. Hospital administrators often need to maintain significant quantities of patient data consisting of information such as admissions, medical history, insurance, and billing. To meet the ever increasing financial demands of providing high quality health care to patient's proper reimbursement from insurance companies is absolutely essential. Complicating the problem is the unique, often hectic, nature of an Emergency Room.
Working under highly stressful conditions, emergency medical team members are routinely forced to forego personalized care in order to balance administrative tasks and treat multiple patients suffering from severe injuries. Often, patients arrive in an Emergency Room with reduced communicative abilities as to their identity, compounded with life threatening injuries that require immediate medical attention. An attending Physician may issue an array of orders ranging from X-rays, administration of medication, and laboratory assays; all of which must be tracked and recorded to insure proper billing and reimbursement. In these situations, it is unacceptable to interfere with the administration of care in order to obtain patient medical care, or resource utilization data. Often when there is interference with the administration of care the patient is ignored as a person and treated as a series of problems. This only adds to anxiety of the patient and increases their feeling of isolation towards the hospital.
A majority of patients initially come to a hospital through the Emergency Room. A patient will inevitably make a decision about using the hospital for future needs, as well as recommending the hospital to others, based on this initial visit and the treatment during that visit. For hospitals to remain viable and competitive, they must make an effort to personalize care in the Emergency Room in order to encourage patients to choose their hospital for future needs.
Furthermore, most patients with insurance obtain their insurance through a membership with an association. Associations can be any group of people from unions to employees of the same company. A need exists for hospitals to implement a marketing agreement with these types of associations. These associations can actively advise their members of the warm and responsive environment in the hospital and the customer friendly atmosphere in the area surrounding the Emergency Room. In return, the hospital can implement a program where a patient belonging to one of these associations can be identified as a qualified patient merely by their membership.
A qualified patient can be identified by uniform, known trademark, employee identification card, or some other means of identification that associates the patient as a member of one the associations. This type of relationship would create revenue for the hospital by increasing the number of people who use the facility and would personalize the experience for the patient.
A need exists for a method to provide emergency health care to patients with insurance. This method would allow hospital administrators to optimize utilization of resources, including utilization of medical personnel, such as nurses, and other medical resources, such as beds, medications, and the like. The method will additionally provide the ability to track effectively the efficiency of patient care provision on a personalized level. This is the ultimate goal of the Emergency Room.
In a broader sense, this method would allow hospital administrators to monitor the cumulative activity of a given department over a time period and assess staff and administrative efficiency as needed to determine if personalized care is being given and if those patients are returning to the hospital for their future needs.
An even more pressing need exists for patients with insurance to get the care they deserve and need and that is covered by an insurance policy that pays the costs of the medical care.